Developmental Dysplasia of the Hip (DDH)

What is DDH?

Developmental Hip Dysplasia is the term used to describe the varying degree of abnormal function of the hip joint. This can occur in utero and also can develop during infancy and childhood. The hip joint is abnormal because the ball is not held firmly into the socket.

Who is affected?

One in 1000 live births are affected. It runs in families. It can be in one or both hips. The left hip is mostly affected. High risk factors include being female, first born or breech position at birth.

When is the baby screened for DDH?

Babies are screened at birth and at well baby check ups by the Pediatrician. If the Pediatrician has concerns, they should refer the baby and parents to an orthopedic surgeon.

What if DDH is left untreated?

If DDH is left untreated, it can lead to pain and osteoarthritis in early adulthood.

Trendelenburg sign - opposite side of pelvis dips during one legged stance

What type of imaging is used?

Ultrasound - most useful image study to confirm anatomy & stability up to 4 months of age

X-ray - not accurate until patient is gestationally four months of age

Arthrogram - dynamic study to assess quality of closed reduction

CT- used to assess a Closed Reduction; also define anatomy in older patients

MRI - maybe used to reduce radiation to patient.

Treatment Groups (done by age): Birth to 6 months

Pavlik Harness

Ensure proper alignment of harness

Harness maybe hand washed and either air dried or with a hairdryer

Releasing harness to decrease risk of AVN(Avascular Necrosis of the femoral head) at least once a day to allow patient to “kick”

Proper fit is:

Comfortable infant

Chest strap below nipple line

Anterior straps hold hips in position

Posterior strap loose!

Hips and knees flexed to 90 degrees

Il felt brace

Used for children after the Pavlik harness. This is used when the child becomes to big or the Pavlik can no longer assist in the hips going to the right position.

Closed Reduction of the Hip

Patient is taken to the operating room for a closed reduction of the hip. The patient is put to sleep with the help of the anesthesia team. The patient does have x-rays in the room.

Patient is placed into a SPICA cast. They are in this case for approximately 4 to 6 weeks initially. The cast is changed at increments in the operating room. The total cast time varies for each patient. The total cast time can last up to 3 months.

The patient is then transitioned into a brace. The brace wear time is determined for each child.

Occasionally an arthrogram is performed. This is when dye is injected into the hip to view the location of the closed reduction. This is often done in conjunction of a CT or MRI.

Car Seat Options with the Cast

We always try your car seat from home. Sometimes we have luck! IF not we have a few loaner car seats available. This below is the Britax Hippo Car Seat.